CHAMPVA CITI: Getting Care at a VA Medical Facility

What is CITI?

It's a way for CHAMPVA family members to get care at a VA facility. 38 CFR 17.270 describes it as participating VA facilities treating CHAMPVA beneficiaries when they have the space and resources.

VA's CITI page says VA covers the entire cost of care you get through CITI. No deductible, no cost share.

Who can use it?

You need all of these:

1. You're enrolled in CHAMPVA.
2. The VA facility participates in CITI.
3. The facility has room and staff for the care you need.
4. You're not eligible for Medicare.
5. Your other insurance, if any, doesn't keep you out. VA says it may affect eligibility, so ask.

Why does Medicare matter?

Because CITI is only for beneficiaries who aren't eligible for Medicare. That's different from CHAMPVA itself, which many people keep after they get Medicare. If you just became eligible for Medicare, tell the VA facility before scheduling.

Does every VA offer it?

No. Participation is local, and services vary by facility. One VA may offer something through CITI that another doesn't. Availability can also change as VA's capacity changes.

How do you find out?

Find the facility with VA's locations tool, then call and say you're asking about CHAMPVA CITI. That keeps you from being routed to Veteran enrollment.

Ask:

1. "Do you participate in CHAMPVA CITI?"
2. "Can you check whether I'm eligible to use CITI here?"
3. "Is [the specific service] available through CITI?"
4. "Does my other insurance affect this?"
5. "How do I schedule?"
6. "If you can't provide it, what happens next and how would outside care be billed?"

Does CITI care need preauthorization?

Usually not. The CHAMPVA Guidebook says services that normally need preauthorization don't need it when provided through CITI. VA's CHAMPVA care page gives medical equipment and mental health care as examples.

What if the VA sends you to a community provider?

That care isn't CITI anymore. VA says you may have to pay part of the cost.

Before that appointment, ask:

• Who arranged the referral, and who is the provider?
• Will the provider bill CHAMPVA?
• Does the care need its own CHAMPVA preauthorization?
• What deductible or cost share should you expect?

The usual CHAMPVA rules apply to that visit. More here: CHAMPVA cost share.

Is CITI the same as VA health care?

No. CITI uses VA buildings, but it's a CHAMPVA program. A Veteran's own VA health care and VA Community Care rules are separate. More here: CHAMPVA vs. TRICARE vs. VA health care.

Before your first CITI visit

• Your CHAMPVA is active.
• The facility confirmed it participates.
• You told them about other insurance and any Medicare eligibility.
• The specific service is available through CITI.
• You know what happens if they need to send you out.